This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Access to a website which supports self-management of eczema led to less severe eczema symptoms. Research found that parents of children with eczema, and young people with the condition, both benefitted.
People with eczema can have dry, itchy, cracked and sore skin. This common long-term condition can have a substantial impact on quality of life. Parents or carers, and young people themselves, may struggle to avoid triggers for eczema, and can find treatments complicated. People with eczema say they receive insufficient or conflicting information.
Website content was based on evidence and expert consensus, and developed by researchers working with expert clinicians and people with eczema; users gave extensive feedback during development. Interactive elements include a quiz, videos, stories and advice from others with eczema.
One version of the website is aimed at parents and carers of children with eczema; another for young people starting to self-manage their eczema. The team conducted randomised controlled trials to test each version. All children and young people received usual eczema treatments. In addition, half were given access to a standard website providing information about eczema, the others had access to the new website.
Both trials found that those with access to the new website had greater improvements in symptoms after 24 weeks, this benefit was sustained at 1 year. Improvements were small but significant. The researchers say the websites increased the confidence of parents and young people in managing their condition.
The website, EczemaCareOnline, is free to use without registration. The researchers hope professionals will encourage carers and young people to use it.
The issue: can a website help people manage their eczema?
About 1 in 5 children and 1 in 10 adults in the UK have eczema; the National Eczema Society says this long-term condition can affect wellbeing and make people angry, embarrassed and lacking in confidence. Moisturising creams (emollients) are recommended for daily use, along with flare control creams (topical corticosteroids) to treat flare ups. People are advised to avoid eczema triggers, such as soap.
UK guidelines recommend educating children and their parents about the condition. But advice can be confusing. People may need to use soap substitutes, regular moisturising creams (emollients) and different flare control creams (topical corticosteroids) for different parts of the body.
Studies have shown that face-to-face eczema education sessions can improve symptoms. But many people who sign up don’t attend, and programmes are costly to run. Prior to these trials, there was little evidence to support online self-management support for eczema.
Researchers worked with clinicians (GPs, specialist nurses and dermatologists) and people with eczema to create EczemaCareOnline to help the parents of children with eczema, and young people themselves, manage their condition. The website is interactive and includes videos, stories and advice from others with eczema. They wanted to see if the online support improved symptoms more than standard advice.
What’s new?
98 GP practices in England took part in the trials. The first included 340 parents and carers of children (0 – 12 years) with eczema; the second, 337 young people (13 – 25 years) with eczema. The eczema was mild-to-severe.
All participants received usual eczema treatments (moisturising creams, flare control creams and access to their usual healthcare). In both trials, half were also given access to the EczemaCareOnline website. The others had access to information on a standard website about eczema management. Participants completed an online questionnaire about eczema symptoms every 4 weeks for 1 year.
For both children and young people, the trials found that eczema symptoms improved more in the website group than in the standard care group. The benefit was small but meaningful, and persisted for 1 year. Improvements were the same regardless of age, gender, eczema severity, and use of eczema treatments at the start of the study.
People with access to the website had better understanding and were more able to manage eczema at both 24 weeks and 1 year. One young person said: ‘I understand it a lot more now […] the doctors tell you what to do with [two creams], rather than what they do and they don’t really explain what eczema is […] I think understanding eczema, you understand how to treat it yourself better.’
Parents and carers said the website made them more confident in managing their child’s eczema. They appreciated the tips on involving their child in treatment and said it prompted positive conversations with their children about eczema.
The resources offered quick answers which could mean GP appointments were not always needed: ‘I can just go to the website and I can quickly get an answer […] Before […] I’d have to take time off school to get a doctor’s appointment and also might not be able to get the doctor’s appointment when it’s really bad.’
Most people given access to the website viewed at least the home page (88% of parents and carers; 92% of young people).
Why is this important?
These are the first large-scale trials to show that online support can reduce eczema symptoms. The improvements, while significant, were smaller than the team hoped for. But the researchers say that any meaningful improvement can mean the difference between waking up every night with their eczema versus waking up most nights.
People with eczema say they lack information and can struggle to manage their condition. This study suggested that people who used the new website could understand and manage their condition better than those given standard information.
What’s next?
EczemaCareOnline is freely available. As of March 2023, more than 14,500 people in 142 countries had accessed it.
A link to the website has been embedded within software used by GPs and other primary care clinicians to help them signpost patients. The research team is looking for more ways to make it easy for healthcare professionals to encourage people with eczema to use the website; they believe it could result in substantial health benefits if widely shared with people with eczema.
You may be interested to read
This Alert is based on: Santer M, and others. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. British Medical Journal 2022;379:e072007.
Study participants' views: Greenwell K, and others. ‘Eczema shouldn’t control you; you should control eczema’: qualitative process evaluation of online behavioural interventions to support young people and parents/carers of children with eczema. British Journal of Dermatology 2022; doi.org/10.1093/bjd/ljac115.
A video and plain English summary of the study.
The National Eczema Society and Eczema Outreach Support also provide information and practical advice about eczema.
Funding: This study was funded by the NIHR Programme Grants for Applied Research.
Conflicts of Interest: The researchers have no relevant interests to declare. A full list can be found on the original research paper.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
